Desempenho do escore O-RADS RM para avaliação de massas anexiais, com notas técnicas

Pereira, Patrick Nunes; Yoshida, Adriana; Sarian, Luís Otavio; Barros, Ricardo Hoelz de Oliveira; Jales, Rodrigo Menezes; Derchain, Sophie

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Radiol Bras 55 (3) • May-Jun 2022 • https://doi.org/10.1590/0100-3984.2021.0050 copiar

Desempenho do escore O-RADS RM para avaliação de massas anexiais, com notas técnicas

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo:

Determinar o desempenho do escore de ressonância magnética para lesões anexiais ovarianas (escore O-RADS RM), com notas técnicas sobre seus atuais parâmetros e conceitos de RM utilizados.

Materiais e Métodos:

Este estudo incluiu 226 pacientes com 287 massas anexiais (190 pacientes submetidas a cirurgia/biópsia e 97 pacientes com pelo menos um ano de seguimento). Calculamos sensibilidade, especificidade, valores preditivos positivos e negativos para as categorias do escore O-RADS RM, usando ≥ 4 como ponto de corte para malignidade. Realizamos análise técnica das principais atualizações do escore, anunciadas em setembro de 2020 pelo American College of Radiology, em comparação com a versão original de 2013.

Resultados:

Escores O-RADS RM categorias 4 ou 5 foram associados com malignidade da massa anexial, com sensibilidade de 91,11% (IC 95%: 83,23-96,08), especificidade de 94,92% (IC 95%: 90,86-97,54), valor preditivo positivo de 89,13% (IC 95%: 81,71-93,77), valor preditivo negativo de 95,90% (IC 95%: 92,34-97,84) e acurácia de 93,73% (IC 95%: 90,27-96,24).

Conclusão:

Este estudo reforçou o uso do escore O-RADS RM para avaliar massas anexiais, principalmente as indeterminadas por ultrassom. As atualizações feitas recentemente no escore O-RADS RM facilitam sua interpretação e permitirão seu uso mais difundido, sem perder a precisão diagnóstica.

Unitermos:
Ressonância magnética; Doenças dos anexos/diagnóstico por imagem; Neoplasias ovarianas/diagnóstico por imagem

Score-risk category	PPV	MRI findings
1 - Normal ovaries	—	Non-ovarian lesion. Follicle (simple cyst ≤ 3 cm), corpus luteum, or hemorrhagic cyst in a premenopausal woman. Unilocular cyst with any type of fluid content (no enhancing wall or solid tissue^* * Solid tissue is defined as a lesion component that enhances and conforms to one of these morphologies: papillary projection; mural nodule; irregular septation/wall; or other larger solid portions. ).
2 - Almost certainly benign	< 0.5%	Unilocular cyst with simple or endometrial fluid content (smooth enhancing wall and no enhancing solid tissue). Lesion with lipid content^† † Minimal enhancement of Rokitansky nodules in a lipid-containing lesion does not change the classification to O-RADS MRI 4. and no enhancing solid tissue. Lesion with “dark T2/dark DWI” solid tissue (homogeneously hypointense on T2 and DWI).
3 - Low risk	≈ 5%	Unilocular cyst with proteinaceous, hemorrhagic or mucinous fluid content (smooth enhancing wall and no enhancing solid tissue). Multilocular cyst with any type of fluid content and no lipid content (smooth septa, wall enhancement, and no enhancing solid tissue). Lesion with solid tissue (excluding T2 dark/DWI dark): low-risk (type 1) time-intensity curve on DCE MRI.
4 - Intermediate risk	≈ 50%	Lesion with solid tissue (excluding T2 dark/DWI dark): intermediate-risk (type 2) time-intensity curve on DCE MRI; if DCE MRI is not feasible, score 4 is any lesion with solid tissue (excluding T2 dark/DWI dark) that is enhancing ≤ myometrium at 30-40s on non-DCE MRI. Lesion with lipid content with large volume enhancing solid tissue.
5 - High risk	≈ 90%	Lesion with solid tissue (excluding T2 dark/DWI dark): high risk time-intensity curve on DCE MRI if DCE MRI is not feasible, score 5 is any lesion with solid tissue (excluding T2 dark/DWI dark) that is enhancing > myometrium at 30-40s on non-DCE MRI. Peritoneal, mesenteric, or omental nodularity or irregular thickening, with or without ascites.

Characteristic	n (%)
Means of establishing the diagnosis
Imaging follow-up findings (≥ 1 year)	97 (33.80)
Histopathological results	190 (66.20)
Benign disease	100 (34.84)
Ovarian
Endometrioma	1 (0.35)
Benign germ cell tumor	20 (6.97)
Cystadenoma	39 (13.59)
Stromal tumor	8 (2.79)
Endometrioma/endometriosis	11 (3.83)
Ovarian torsion or necrosis	3 (1.04)
Functional non-neoplastic cysts	7 (2.44)
Non-ovarian	11 (3.83)
Malignant disease	90 (31.36)
Ovarian borderline	17 (5.92)
Serous tumor	11 (3.83)
Mucinous tumor	4 (1.39)
Seromucinous tumor	2 (0.70)
Invasive malignant	73 (25.44)
Ovarian cystadenocarcinoma	44 (15.33)
Ovarian stromal tumors	5 (1.74)
Ovarian germ cell tumors	3 (1.04)
Anaplastic tumor	1 (0.35)
Metastasis	7 (2.44)
Non-ovarian tumor	13 (4.53)

Statistic^† † The sensitivity, specificity, positive predictive value, and negative predictive value were computed for dichotomized scores: scores of 1, 2, and 3 (benign) vs. scores of 4 and 5 (malignant).	Value	95% CI
Sensitivity	91.11%	83.23-96.08
Specificity	94.92%	90.86-97.54
Positive likelihood ratio	17.95	9.78-32.94
Negative likelihood ratio	0.09	0.05-0.18
Disease prevalence	31.36%	26.03-37.07
Positive predictive value	89.13%	81.71-93.77
Negative predictive value	95.90%	92.34-97.84
Accuracy	93.73%	90.27-96.24

Result	Key imaging finding
False negative (n = 8)
Five borderline tumors	No clearly solid component in four and a type 1 time-intensity curve in one
One mucinous ovarian carcinoma	No clearly solid component
One malignant Brenner tumor	Type 1 time-intensity curve
One endometrioid ovarian carcinoma	Type 1 time-intensity curve
False positive (n = 10)
Four serous cystadenomas	Type 2 time-intensity curves
Three fibromas	Type 2 time-intensity curves
One thecoma	Type 2 time-intensity curve
One round ligament myoma	Type 2 time-intensity curve
One peritoneal inclusion cyst	Type 2 time-intensity curve

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Dr. Patrick Nunes Pereira. Departamento de Tocoginecologia - FCM-Unicamp. Rua Tessália Vieira de Camargo, 126, Cidade Universitária. Campinas, SP, Brazil, 13083-887. patricknunes@gmail.com.